Paradoxical adipose hyperplasia - more CoolSculpting?

I had coolsculpting done on my upper arms in February 2016 and my lower abs in March 2016. I didn't have any problems. Since I didn't have any issues with paradoxical adipose hyperplasia, I should be fine if I did a second treatment on my lower abs again?

Doctor Answers 9

CoolSculpting and PAH

Thank you for your question. Yes, you can have a second Coolsculpting treatment. Paradoxical Adipose Hyperplasia is not common. It generally occurs 2-3 months after treatment. It is not likely that this will develop after having successful treatments earlier in the year. 

Summit Emergency Medicine Physician
5.0 out of 5 stars 45 reviews

More CoolSculpting=More PAH?

Hello Beliaaa78,

Thank you for sharing your questions and concerns. PAH with CoolSculpting is a very rare occurrence, this coupled with your previous success with multiple cycles of CoolSculpting it would appear quite safe for you to continue with additional cycles of your abdomen to obtain the results you desire. Be well. 

Paul Pietro, MD
Greenville Physician
5.0 out of 5 stars 3 reviews

CoolSculpting and PAH

Yes, you should be fine doing a second treatment on the area since there was no previous PAH.  PAH is very rare from CoolSculpting.

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 reviews


You are highly unlikely to have PAH after two successful treatments.  Good luck with your continued treatments!

Michelle Ellern, DO
Livingston Physician
5.0 out of 5 stars 3 reviews

This just does not make sense... PAH?!

Fat cells which are treated with cryolipolysis are induced to a state of cell death called apoptosis. This usually takes about 3 months to be fully realized. In a very small number of patients it is almost as if the reverse occurs. In practices that do many procedures this is more likely to be seen. It does not seem as though this is a result of poor patient selection although that can also result in suboptimal results. 

In a patient where such a situation occurs, it is advantageous to be seeing a board certified plastic surgeon who can evaluate you for possible minimally invasive procedures such as SmartLipo or traditional liposuciton to help you achieve you desired goal. 

If you have had treatment in other ares of your body you are more likely than not going to have a very reasonable result and not encounter PAH..

R. Brannon Claytor, MD, FACS
Bryn Mawr Plastic Surgeon
5.0 out of 5 stars 41 reviews


You should be fine.  A good previous outcome portends a good future outcome with cool sculpting.  Hope this helps.

Bhupesh Vasisht, MD
Voorhees Plastic Surgeon
5.0 out of 5 stars 86 reviews

Paradoxical adipose hyperplasia - more CoolSculpting?

Thank you for the question. It is great to hear that you had a successful first treatment. Knowing this it is less likely that you may have PAH. Good luck. 

Himansu Shah, MD
Las Vegas Plastic Surgeon
5.0 out of 5 stars 17 reviews

Paradoxical Adipose Hyperplasia

Hi Bella,

Thank you for your question.  Paradoxical Adipose Hyperplasia (PAH) is uncommon.  It typically occurs (becomes visible) 2 or 3 months after treatment and may effect all areas treated.   It is unlikely that you will develop PAH after successfully undergoing treatments earlier this year.  Incidentally, although the occurance of PAH is low, it may be even lower with the use of the new advantage applicator which requires less treatment time and is more comfortable than the "older applicators"  

Good Luck,  BeverlyFriedlander, MD

Beverly Friedlander, MD
Short Hills Plastic Surgeon
4.8 out of 5 stars 16 reviews

Getting the Most out of Coolsculpting!--Add Vanquish, Venus Legacy, Exilis Ultra, Cellutone

Yes, you can have a second treatment of Coolsculpting. With Coolsculpting I recommend adding a combination with radiofrequency treatments such as Vanquish, Venus Legacy, Exilis Ultra with Z wave/Cellutone for best results. VASER Hi Def with ThermiRF, ultrasound and fat grafting are also options, if you're a candidate. See an expert. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.